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General NPI Number Information
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NPI Number | 1801805981
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Entity Type | Individual
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Provider Name | DOUGLAS M. TILLEY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 17460 IH 35 N STE 120
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City | SCHERTZ
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State | TX
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Zip | 78154-1209
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Country | US
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Telephone | 210-651-5988
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Fax |
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Provider Business Mailing Address
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Address Line | 8502 ACROPOLIS DR
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City | UNIVERSAL CITY
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State | TX
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Zip | 78148-2636
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Country | US
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Telephone | 210-658-1417
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10486
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License Number State | TX
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